DIAGNOSTIC YIELD OF NEUTROPHIL TO LYMPHOCYTE RATIO (NLR) IN PREDICTING SPONTANEOUS BACTERIAL PERITONITIS IN PATIENTS WITH CIRRHOTIC ASCITES
DOI:
https://doi.org/10.71000/0n9g0f91Keywords:
Ascites, Cirrhosis, Diagnosis, Neutrophil-to-Lymphocyte Ratio, Paracentesis, Predictive Value of Tests, Spontaneous Bacterial PeritonitisAbstract
Background: Spontaneous bacterial peritonitis (SBP) is a serious and potentially fatal complication of cirrhotic ascites. The current gold standard for SBP diagnosis is ascitic fluid polymorphonuclear leukocyte (PMN) count >250 cells/mm³, an invasive procedure with inherent risks. A reliable, non-invasive diagnostic tool is urgently needed. The neutrophil to lymphocyte ratio (NLR) has emerged as a potential biomarker, reflecting systemic inflammation and immune dysregulation in liver cirrhosis.
Objective: To validate the diagnostic accuracy of neutrophil to lymphocyte ratio in predicting spontaneous bacterial peritonitis in patients with cirrhotic ascites, using ascitic fluid PMN count as the gold standard.
Methods: This cross-sectional validation study was conducted at the Department of Medicine, Khyber Teaching Hospital, Peshawar. A total of 127 patients aged 18–70 years with cirrhotic ascites and suspected SBP were enrolled using consecutive non-probability sampling. Patients underwent blood investigations and diagnostic paracentesis. NLR was calculated from peripheral blood counts, and ascitic fluid was analyzed for PMN count, protein, and culture. SBP was defined as PMN >250 cells/mm³. Diagnostic performance of NLR was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the ROC curve (AUC).
Results: SBP was confirmed in 52 patients (40.9%). At a cut-off NLR >3.5, the test showed sensitivity of 84.6%, specificity of 88.2%, PPV of 74.6%, NPV of 93.5%, and overall diagnostic accuracy of 86.6%. The ROC curve yielded an AUC of 0.91 (95% CI: 0.86–0.96), indicating excellent discriminatory power.
Conclusion: NLR is a reliable, rapid, and non-invasive diagnostic marker for SBP in cirrhotic ascites. Its routine use may facilitate earlier diagnosis and improved outcomes, especially in settings where paracentesis is limited.
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